The effect of the base on the kinetics of action of the capsaicinoid nonivamide: evaluation with a hyperemic test

Because of their selective receptor-mediated action on cutaneous nociceptive C-fibers, the interest in capsaicinoids as topical analgetic drugs has been constantly growing over the past years. Knowledge of the pharmacokinetics seems particularly important for potential future clinical applications. Therefore, the aim of the present study was to investigate the influence of the type of preparation on the time course of action of the capsaicinoid nonivamide monitored by the axon-reflex-induced hyperemic action and area of erythema. Sixteen healthy subjects were included in the study. The hyperemic responses after application of nonivamide in an oil-in-water (O/W) emulsion and in a water-free ointment were assessed both by laser Doppler perfusion imaging and planimetry after 0, 15, 30, 45, 60, 120 and 240 min. They were compared with the reaction after application of the nicotinic ester nicoboxil and a combination of nonivamide and nicoboxil in the same preparations. Applied as a water-free ointment, nonivamide showed a slow onset of hyperemic action, reaching its maximum 45 min after application. When applied as an O/W emulsion, however, the increase in effect was high, reaching its maximum already after 30 min. Application of the nicoboxil preparations revealed a clearly lesser influence of the base regarding the onset of maximum effect. The combination of both substances showed an additive effect for both bases, and a maximum effect was found already after 15 min with both the water-free ointment and the O/W emulsion base. In conclusion, the results of the present study show that there appears to be a strong influence of the vehicle on the kinetics of action of capsaicinoids, and that the hyperemic test used in this paper is very useful for the quantitative determination of the pharmacokinetic properties of capsaicinoids. Moreover, the C-fiber-stimulating effect of capsaicinoids can, at least in part, be enhanced by combination with a nicotinic ester, even though these substances have no direct effect on the C-fibers.

[Short assessment of subjective quality of life. Application and results of a short form of the Berliner Lebensqualitätprofil (BELP-KF)]

The concurrent validity between the Berliner Lebensqualitätsprofil (BELP) and a new developed short form (BELP-KF) was tested in a sample of schizophrenia outpatients (N = 36) and turned out to be very high. The restriction to subjective quality of life questions did not lead to a greater halo-effect in the sense of an increasing similarity of single item values. Correlations with psychopathological symptoms were almost identical for both interview-versions. The same is true concerning the factorial structure of the satisfaction items which was nearly congruent. Two optional items on satisfaction with sexual life and with psychopharmacological treatment, which had been included into the short interview version, were attributable to an underlying general satisfaction dimension. Among 14 variables satisfaction with psychopharmacological treatment had the second highest factor-loading on the resulting general satisfaction factor.

Femtosecond two-photon excited fluorescence of melanin

Fluorescence of synthetic melanin in dimethyl sulfoxide has been excited by two-photon absorption at 800 nm, using 120 fs pulses with photon flux densities > or = 10(27) cm-2 s-1. The shortest main component of the three-exponential decay of fluorescence is 200 +/- 2 ps. The overall spectral shape is red-shifted with respect to the 400 nm excited fluorescence. Two-photon excited melanin fluorescence also has been measured from excised samples of healthy human skin tissue. Because of the selectivity of melanin excitation via resonant two-photon absorption, it is hypothesized that fluorescence excited in this way may yield information on malignant transformation.

Molecular farming of recombinant antibodies in plants

'Molecular farming' is the production of recombinant proteins in plants. It is intended to harness the power of agriculture to cultivate and harvest transgenic plants producing recombinant therapeutics. Molecular farming has the potential to provide virtually unlimited quantities of recombinant antibodies for use as diagnostic and therapeutic tools in both health care and the life sciences. Importantly, recombinant antibody expression can be used to modify the inherent properties of plants, for example by using expressed antipathogen antibodies to increase disease resistance. Plant transformation is technically straightforward for model plant species and some cereals, and the functional expression of recombinant proteins can be rapidly analyzed using transient expression systems in intact or virally infected plants. Protein production can then be increased using plant suspension cell production in fermenters, or by the propagation of stably transformed plant lines in the field. Transgenic plants can be exploited to produce organs rich in a recombinant protein for its long-term storage. This demonstrates the promise of using transgenic plants as bioreactors for the 'molecular farming' of recombinant therapeutics, blood substitutes and diagnostics, such as recombinant antibodies.

Multimodal time-variant signal analysis of neonatal EEG burst patterns

It can be shown that dominant rhythmic signal components of neonatal EEG burst patterns (discontinuous EEG in quiet sleep) are characterized by a quadratic phase coupling (bispectral analysis), i.e. a multiplicative interaction (connection) between the underlying electrophysiological processes can be assumed. By means of pattern recognition algorithms as well as time-variant spectral and coherence analysis, a so-called "initial wave" (narrow band rhythm within a frequency range of 3-12 Hz) can be demonstrated within the first part of the burst pattern. The detection of this signal component and of the quadratic phase coupling is more successful in the frontal region. By means of amplitude demodulation of the "initial wave" the phase coupling can be attributed to an amplitude modulation. The results were derived from 6 neonates (20 burst patterns for each neonate; 8-channel recordings). A 16-channel EEG-recording was analyzed for one neonate.

UV transmission and UV protection factor (UPF) measured on split skin following exposure to UVB radiation--correlation with the minimal erythema dose (MED)

In this study the ultraviolet (UV) transmission of split skin exposed to UVB radiation and of non-exposed skin was compared in the 280-390 nm wavelength range and quantified. In addition, the correlation between the increase in the minimal erythema dose (MED) associated with a defined exposure to UVB and the ultraviolet protection factor (UPF) calculated from the transmission data was investigated. The study population consisted of 12 patients. Two pieces of split skin of the same thickness (0.3 mm) were taken from the right thigh of each patient. One specimen was removed from an area of non-exposed healthy skin and the other from an area which had been exposed to UVB radiation for a period of 12 days in which the initial dose of 1/3 MED was raised by 1/3 MED every 4 days. The split skin specimens were stretched over a special frame; subsequently, the UV transmission was determined with a spectrophotometer. The mean values obtained for UV transmission were all significantly below the initial data for non-exposed split skin. In the UV range of 280--390 nm, the transmission measured in the exposed specimens was 49.1% of the value measured in the non-exposed split skin (P<0.05). The corresponding values for the UVA range (315--390 nm) and the UVB range (280--315 nm) were 50.1% and 29.5%, respectively (P<0.05), based on the initial transmission data obtained from non-exposed skin. The clinical determination of MED after 12 days of exposure to UVB yielded mean values that were 3.2 times the initial values. Moreover, the mean UPFs calculated from the transmission data measured at the end of the 12-day exposure period were also about three times the initial values. The present study has thus established a significant correlation between the clinical MED values and the UPFs calculated from the transmission data measured following exposure to UVB.

[Ranking of 20 MHz sonography of malignant melanoma and pigmented lesions in routine diagnosis]

PURPOSE

Eleven dermatology clinics from all over Germany took part in our multicenter prospective study with the aim of evaluating 20 MHz sonography in the preoperative diagnosis of malignant melanomas and other pigmented skin tumours. It was to be assessed how effective sonographic measurement of thickness would compare to histology and the clinical palpation of tumour thickness and also the significance of differential diagnosis in sonography of malignant melanomas.

METHOD

The prospective multicenter study proceed as follows. To the end of August 1997 264 patients with a primary malignant melanoma and 417 patients with benign skin tumours were examined via 20 MHz sonography. Two different examiners estimated the clinical thickness of the tumour by palpation. The tumour was then excised and examined for postoperative correlation with the histology sections.

RESULTS

The final results showed good correlation between the histological and sonographic estimation of tumour thickness (r = 0.97). Estimation of tumour thickness by palpation showed no correlation with the histology (r = 0.59). Most of the benign (44%) and malignant tumours (38.7%) were spindle shaped. There was no significant difference between the benign and malignant tumour groups in relation to the sonographic presented shapes or echo signs. No different diagnosis could be made.

CONCLUSION

The technique of high frequency sonography in relation to preoperative diagnosis of malignant melanomas has high priority. In contrast to clinical estimation of tumour thickness, sonography provided a good correlation to histology. The effectiveness of sonography with regard to the valence of the skin tumours is limited and there is no possibility of differentiating between malignant and benign tumours from the morphological face value. Hence, there is a demand for developing a 150 MHz apparatus which will be able to supply evidence regarding the valence of skin tumours.

Megakaryocytic growth in patients with refractory anemia is suppressed by treatment with interferon alpha

IFN alpha alone or in combination with retinoids or haematopoietic growth factors has been used to treat patients with early MDS because of its properties as a differentiation inducing agent. We investigated whether treatment of patients with refractory anemia (RA) with IFN alpha (1.5x10(6) IU twice a week) and intermittent all-trans retinoic acid (ATRA, 25 mg/m2/d) influences in-vitro megakaryocytic (MK) proliferation and differentiation stimulated by PEG-rHuMGDF. Low-density non-adherent bone marrow (BM) cells from 8 patients with RA were assayed prior to any treatment other than supportive and after a period of 6 months of treatment. MK development was assayed in suspension cultures in the presence of PEG-rHuMGDF and SCF for 7 d using morphological criteria and flow cytometric analysis of CD42b (GP1b) positive cells. BM-cells from 10 healthy individuals served as control. Following stimulation with PEG-rHuMGDF 23+/-7% and 16+/-4% of control cells were CD42b positive after 5 and 7 d of cultures, respectively. In cultures of cells from MDS patients prior to treatment 8+/-2% and 7+/-3% of cells were CD42b+ on days 5 and 7. In the course of IFN alpha treatment cultures of all BM samples from these MDS patients revealed a significant reduction of MK precursor cells (3+/-2%, CD42b+, p=0.03 and 0.04). In conclusion, treatment with TFN alpha and ATRA did not result in improved megakaryocytopoiesis as assessed by in-vitro cultures. On the contrary, low-dose IFN alpha appears to suppress cell proliferation as well as MK development.

A non-isotopic assay for histone deacetylase activity

Inhibitors of histone deacetylase (HD) bear great potential as new drugs due to their ability to modulate transcription and to induce apoptosis or differentiation in cancer cells. To study the activity of HD and the effect of potential inhibitors in vitro so far only radio-active assays have existed. For the search of new inhibitors and for the use in HD identification and purification we established a simple, non-radioactive assay that allows screening of large numbers of compounds. The assay is based on an aminocoumarin derivative of an Omega-acetylated lysine as enzyme substrate.

[Prevalence of psychological symptoms in dermatologic patients of an acute clinic]

There is a lot of information in the literature about psychological disturbances in somatic diseases. For dermatological patients such data are not available. In early spring 1998 we studied the psychological changes in 247 hospitalized patients in the dermatological department of the Ruhr University Bochum. We used the German version of the internationally accepted Hospital Anxiety and Depression Scale. We found the prevalence of psychological alterations ranged between 25.9% and 31%. The prevalence of psychological disturbances was a little higher than that seen in oncological, cardiological or neurological patient populations. Surprisingly skin cancer patients were less affected than patients with chronic inflammatory or angiological diseases. These results underline the necessity of improved psychological therapeutical strategies which must be standardized and evaluated.

[Depression and suicidal intentions as a side effect of high dosage interferon-alpha therapy--two cases]

Adjuvant therapy with interferon for malignant melanoma causes neurotoxic side effects such as depression. The biochemical mechanisms are unknown. We report two cases with both depression and amnesia. In one case, attempted suicide was accompanied by 7 h of amnesia. The diagnostic classification and possible explanations for the amnesia secondary to interferon therapy are reviewed.

Treatment of patients with low-risk myelodysplastic syndromes using a combination of all-trans retinoic acid, interferon alpha, and granulocyte colony-stimulating factor

Used as single agents, ATRA, G-CSF, and IFN-alpha have shown a moderate benefit in patients with low-risk MDS, with a response rate of 10%. The aim of the present study was to evaluate the efficacy of a combination of these agents. The effect on hemoglobin (Hb), platelets, and absolute neutrophil count (ANC), as well as on transfusion frequency, was examined in 25 patients with MDS (11 RA, four RARS, eight RAEB, two CMML). The median age was 61 years (range 44-81), and the male/female ratio was 14/11. Treatment consisted of ATRA at 25 mg/m2/day p.o. for months 1, 3, 5, 7, 9, and 11, IFN-alpha at 1.5 MIU twice a week s.c. for 52 weeks, and, in patients with initial ANC <500/microl, G-CSF at 100-480 microg daily s.c. according to the degree of ANC. The duration of therapy was scheduled for 12 months. Two patients achieved ongoing CR (+19 months; +16 months), one patient with RA after 3 months and one with CMML after 7 months of treatment. In all patients, the mean ANC increased significantly from 1400+/-200/microl before the start of therapy to 3500+/-600/microl at the end of treatment (p=0.025). In two patients an increase of Hb was observed, and one patient ceased to require transfusions. In an additional patient with RA and 5q-syndrome, the platelet count normalized following administration of ATRA/IFN-alpha, increasing from 89,000/microl to 293,000/microl. The eight RAEB patients were nonresponders. We conclude that therapy with ATRA, IFNalpha, and G-CSF is effective in approximately 35% of low-risk MDS patients (in this study: six of 17) and may induce complete remission in individual cases.

Blood flow compared in benign melanocytic naevi, malignant melanomas and basal cell carcinomas

Histologically, increasing malignancy is reflected by increased tumour vascularization. We therefore assessed whether laser Doppler perfusion imaging might allow differentiation between different types of skin tumour. The perfusion patterns of 27 melanocytic naevi, 16 basal cell carcinomas and six malignant melanomas were examined with a laser Doppler perfusion imager before excision for precise diagnosis. Malignant melanomas were significantly more perfused than basal cell carcinomas and tended also to be more so than melanocytic naevi. Further, for the first time, the perfusion pattern of the entire tumour area was visualized two-dimensionally; it was higher in the centre of the tumours than at the periphery for malignant melanomas and melanocytic naevi but was the same throughout for basal cell carcinomas. Laser Doppler perfusion imaging can thus provide information to assist in the differential diagnosis of skin tumours. In addition, with increases in resolution of the technique such data may well become steadily more useful in the future.

Adenoviral gene transfer of the human V2 vasopressin receptor improves contractile force of rat cardiomyocytes

BACKGROUND

In congestive heart failure, high systemic levels of the hormone arginine vasopressin (AVP) result in vasoconstriction and reduced cardiac contractility. These effects are mediated by the V1 vasopressin receptor (V1R) coupled to phospholipase C beta-isoforms. The V2 vasopressin receptor (V2R), which promotes activation of the Gs/adenylyl cyclase system, is physiologically expressed in the kidney but not in the myocardium. Expression of a recombinant V2R (rV2R) in the myocardium could result in a positive inotropic effect via the endogenous high concentrations of AVP in heart failure.

METHODS AND RESULTS

A recombinant adenovirus encoding the human V2R (Ad-V2R) was tested for its ability to modulate the cardiac Gs/adenylyl cyclase system and to potentiate contractile force in rat ventricular cardiomyocytes and in H9c2 cardiomyoblasts. Ad-V2R infection resulted in a virus concentration-dependent expression of the transgene and led to a marked increase in cAMP formation in rV2R-expressing cardiomyocytes after exposure to AVP. Single-cell shortening measurements showed a significant agonist-induced contraction amplitude enhancement, which was blocked by the V2R antagonist, SR 121463A. Pretreatment of Ad-V2R-infected cardiomyocytes with AVP led to desensitization of the rV2R after short-term agonist exposure but did not lead to further loss of receptor function or density after long-term agonist incubation, thus demonstrating resistance of the rV2R to downregulation.

CONCLUSIONS

Adenoviral gene transfer of the V2R in cardiomyocytes can modulate the endogenous adenylyl cyclase-signal transduction cascade and can potentiate contraction amplitude in cardiomyocytes. Heterologous expression of cAMP-forming receptors in the myocardium could lead to novel strategies in congestive heart failure by bypassing the desensitized beta-adrenergic receptor signaling.

[Laparoscopy in the newborn infant--indications and procedure]

The indications and technical features of minimal invasive surgery, which is of particular interest in neonates, are being discussed. Thirty-three laparoscopies had been performed as of 1997. The youngest child was 2 days old; the smallest one weighted 2150 g. The most frequent indications were clarification of cholestasis, cystic masses, pyloromyotomies and sigmoid resections. Three conversions were necessary (two choledochal cysts, splenic torsion). Complications were one postoperative incisional hernia and two rectal stenoses after sigmoid resection.

CONCLUSION

Laparoscopy can even be performed in newborns and meets the requirements of minimally invasive surgery.

[Discharge in inpatient care. Results of a survey. Postscript to part III of the Berlin Deinstitutionalization Study]

PURPOSE

42 percent long-term patients from the Berlin Deinstitutionalization Study sample have been discharged to full-time institutional settings.

METHODS

The questionnaires of a mail-survey covered features of 58 different non-hospital full-time institutional settings and care for a group of 125 long-term mental patients.

RESULTS

The return rate was more than 70 percent. For 78 percent of the discharged former long-term inpatients the political goal of complete psychiatric care in the patient's home area has been reached, but only 20 percent live in smaller institutions of up to 40 places.

CONCLUSIONS

The significance of other data of the survey does not exceed that of stock-taking and certain indications because of the selective data and the limitations of the method. There is an urgent need for further research in examining the quality of non-hospital institutional care for psychiatric long-term patients.

[Phototherapy in severe atopic dermatitis. Comparison between current UVA1 therapy, UVA1 cold light and combined UVA-UVB therapy]

Severe atopic dermatitis, especially when involving the face, does not respond well to conventional therapy. In the present prospective randomized trial, we compared therapeutic efficiency of medium-dose UVA1, medium-dose cold light UVA1 (15 treatment courses with 50 J/cm2 each) and combined UVA-UVB phototherapy. Four (13.3%) of 30 UVA1 treated patients, one (3.4%) of 30 UVA1 cold light treated patients and three (30%) of 10 patients treated with combined UVA-UVB discontinued therapy course before finishing treatment protocol because skin status did not improve or even deteriorated. In the other patients treated over a period of three weeks, skin status improved significantly or even cleared completely in 80.8% of UVA1 treated and in 89.7% of UVA1 cold light treated patients resulting in a significant decrease of the SCORAD-Score (UVA1 group from 68.6 +/- SD 10.9 to 29.8 +/- SD 7.1 and UVA1 cold light group from 72.5 +/- SD 13.4 to 23.8 +/- SD 11.6; p < 0.05 each). In the UVA-UVB treated group, the SCORAD-Score also decreased (from 71.0 +/- SD 9.4 to 41.6 +/- 10.5), but significantly less than in both UVA1 treated groups (p < 0.05 each). Four weeks after completing therapy UVA1 treated patients showed a prolonged therapy benefit as compared to UVA-UVB treated patients. Plasma levels of eosinophil cationic protein and soluble interleukin-2 receptor significantly decreased under UVA1 phototherapy but not under UVA-UVB therapy. Compared to conventional UVA1 phototherapy, UVA1 cold light phototherapy showed advantages due to the absence of potentially proinflammatory effects based on temperature-induced increase of skin blood flow (quantified by Laser doppler scanning) and increased sweat production (determined by the patient using a visual analog scale).

Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia patients

Subjective quality of life is an important criterion in outcome evaluation that has been well-researched in psychiatry. By comparison, the therapeutic relationship which may also be subjectively assessed has been relatively neglected as an outcome criterion although it has predictive power in relation to outcome. This exploratory study investigated subjective quality of life and therapeutic relationships in first-admission (N = 90) and long-term (N = 168) schizophrenia patients, each at two points of time. The follow-up period was 9 months for the first-admission sample and 1.5 years for the long-term sample. A significant relationship was found between global assessments of quality of life and therapeutic relationships in long-term, but not in first-admission patients. This finding was consistent at both assessments, suggesting that therapeutic relationships may become more central to quality of life in long-term care situations and that patients' views of this relationship are increasingly embedded in their overall appraisal of life.

Identification of a co-repressor binding site in catabolite control protein CcpA

The catabolite control protein CcpA is the central regulator of carbon catabolite repression in Bacilli and other Gram-positive bacteria. A comparison of 12 CcpA-like sequences with regulators from the LacI/GalR family defines a CcpA subfamily based on extensive similarities found among CcpAs and not in 32 other members of the family. These amino acids are clustered in three blocks in the CcpA sequence. Their interpretation, assuming a PurR-like fold, reveals that almost all of them are surface exposed and form a continuous patch on the N-terminal subdomain of the protein core extending into the DNA reading head. We introduced nine single amino acid exchanges in the subfamily specific residues of CcpA from Bacillus megaterium. Six mutants, namely CcpA47RS, 79AE, 89YE, 295YR, 299YE and 303RD, are inactive or severely impaired in catabolite repression, underlining their relevance for CcpA function. They are negatively transdominant over wild-type CcpA demonstrating their ability to correctly fold for dimerization. Five of them are unable or impaired in binding HPr-Ser-46-P in vitro, establishing a correlation between catabolite repression efficiency and HPr-Ser-46-P binding. These results support the hypothesis that the conserved region in CcpA is the HPr-Ser-46-P binding site.

[100 MHz ultrasound of psoriasis vulgaris plaque]

PURPOSE

20 MHz sonography of inflammatory diseases has concentrated on the evaluation of the echo-poor area in the upper dermis. With regard to higher resolution, this study focuses on the alterations of the epidermis and upper dermis skin using 100 MHz sonography.

METHOD

70 fully developed psoriasis vulgaris plaques of 20 patients were examined using our 100 MHz ultrasound equipment after application of salicylic acid in petrolatum for 24 h. After informing the patient about the aims of the study, a small knife biopsy was taken from 11 plaques.

RESULTS

All psoriasis plaques exhibited, in comparison with normal skin, a significant widening of the skin entry echo (p < 0.001). Focally, this echo-rich line broke up into two thinner lines. Correlating histology exhibited in these areas an orthohyperkeratosis and focal parakeratosis. The upper dermis showed an echo-poor, band-shaped area which corresponded histologically to an acanthosis, elongation of rete ridges, and widening of the stratum papillare. The mean grey level of the echo-poor area and of the dermis beneath was significantly lower (p < 0.001) than the normal adjacent dermis. The thickness of the echo-poor area correlated with the thickness of the sum of the acanthosis and the inflammatory infiltrate in the histological sections (r = 0.94).

CONCLUSION

Using 100 MHz sonography changes of the skin entry echo and the upper dermis can be visualized and quantified.